World Breastfeeding Week 2021: The Successful Establishment of Breast-Feeding
The Physiology of Lactation
Lactation consists of two phases. The first is the secretion of milk by the mammary gland, which begins during pregnancy and is the result of a hormone called prolactin. The second phase is the process of milk ejection whereby the breast becomes full of milk and is available to the infant. This is called the let-down reflex' and is due to the sucking of a baby on its mother's breast. When a child sucks, impulses go to the mother's brain and posterior pituitary, which in turn produces another hormone, oxytocin, oxytocin acts on the breast and milk starts automatically coming into the baby's mouth. Owing to continuous sucking the milk flow is established and milk may even spurt from the nipple not in use; so, mothers should suckle their babies several times a day to establish lactation successfully.
Bottle-feeding with a nipple is the commonest cause of lactation failure, as a baby can suck more easily from a long nipple than from the breast of the mother Therefore, bottle-and-nipple should never be introduced to a newborn: only breast-feeding should be offered.
Human milk is called species-specific and is the natural food for a human baby Breast milk is the very key to the survival of the species, particularly during the first six months of life it is of paramount importance that breast-feeding is continued until the age of two.
- The earliest milk to be secreted is called colostrum and the daily volume produced is small but adequate. Colostrum has a very high protein content but less fat and carbohydrate than the milk that is produced later, its caloric value is 67 kcal per day. Colostrum is more yellow, more alkaline, contains more electrolytes and has a higher specific gravity than mature human milk. It contains more sodium, potassium, and chloride than mature milk and has some immunological features that make it very beneficial against infections. Under no circumstances should it be wasted. Some mothers express the colostrum, either manually or with a breast pump, and throw it away: this amounts to depriving the baby of a most nutritious food, which will protect him or her from infection and facilitate proper weight gain.
- By 3-4 days colostrum changes into transitional milk and 4-6 days later mature milk is produced.
- An infant should be put to the breast as soon as possible after birth, and certainly within four hours, and on demand thereafter, to suck on each breast for five to ten minutes so that the let-down reflex occurs. This will usually be at 2–4-hour intervals initially but a rigid timetable of feeding times for babies under the age of two months is not advisable, babies of this age should be fed on demand.
- Feeding the baby should start alternately on the right and the left breast. The first few sessions should be limited to short periods (3-7 minutes) on each breast. As a rule, a baby should not be allowed more than 20 minutes per feed as most of the milk is taken from the breasts in five minutes and most babies are satisfied after ten minutes. Prolonged sucking, especially in the early days, can lead to sore and cracked nipples. Sometimes babies swallow air along with the milk, especially if they are not well attached to the nipple, and it may be necessary to help them burp, particularly at the end of a feed. In the first few weeks the baby may want to feed frequently, even 30 times a day, but by 6-8 weeks a baby will demand feeding at longer intervals, when he or she feels hungry.
- Water should not be given to a newborn, because the baby will be less inclined to suck if the stomach is full of water and the amount of breast milk taken will be reduced.
- The baby should be kept close to the mother. She should handle the baby herself (change the baby's nappies etc.) as all physical acts of affection help to ensure an adequate milk supply.
- Vitamins C and D should be given Mothers should take regular exercise and should lead normal lives.
To ensure an adequate supply of milk a mother should be told the principles that encourage milk production. She should understand that adequate milk production is proportional to her infant's vigorous sucking and that any inadequate emptying of her breasts will eventually lead to lactation failure. The earlier a baby is put to the breast, the more likely it is that breast-feeding will be successful. In the early days a mother's supply of milk may not match her baby's demands exactly. If a baby cannot take the whole quantity available, the breast should be completely emptied either manually or with a suction pump. Frequent breast-feeding is a potent stimulus to milk production. The closeness of baby and mother is a most important adjunct of successful breast-feeding.
Initially the amount of breast milk produced is small. Later it can rise to about 850 ml per day and this amounts to a loss of 600 kcal per day for the mother. Her diet should therefore be supplemented with this amount daily, and her diet should be rich in proteins and vitamins.
A mother's general health must be good to produce enough milk. Factors like fatigue, pain and cracked nipples may temporarily reduce the amount of breast milk she produces.
Care of the breasts
The care of the breasts should start the antenatal period and is directed towards their proper functioning after the birth of the infant. Milk is secreted during pregnancy, in the last few weeks. The milk-producing ducts of the breasts 'may become obstructed and milk may form crusts over the nipples. In order to avoid this, they must be washed daily. Manual expression of the nipples helps to keep them clear.
Some abnormal abnormalities of the nipples may make it difficult to breast-feed. A daily massage and gently pulling the nipples our is very effective.